CPT 28292
Global 090 ActiveCor hlx vlgs rsc prx phlx bs
CPT 28292 Billing & Documentation Guide
CPT code 28292 (Cor hlx vlgs rsc prx phlx bs) is classified under Surgery (Musculoskeletal) with a global period indicator of 090. The 2026 Medicare Physician Fee Schedule assigns a work RVU of 7.25, a non-facility practice expense RVU of 13.02, and a malpractice RVU of 0.78, a total non-facility RVU of 21.05 and facility RVU of 13.77. With the current conversion factor of $33.4009, the national average non-facility reimbursement is approximately $723.26, though rates vary from $629.14 to $909.85 based on MAC locality and Geographic Practice Cost Indices (GPCIs).
When billing 28292, ensure documentation supports medical necessity and the specific components required for the code's level of service. For E/M codes, document MDM (medical decision-making) elements: problems addressed, data reviewed, and risk. For procedural codes, document the indication, technique, and any complications. Always verify NCCI edits before bundling 28292 with related codes; this code has 10 PTP bundling relationships on file (see table below).
Payment Status & Global Period
Active code (paid under MPFS)
90-day global period (major surgery: 1 day pre-op + procedure + 90 days post-op)
MUE Limit (Medically Unlikely Edits)
Submitting more than 1 units of 28292 for the same patient on the same date triggers automatic line denial unless an appropriate modifier and supporting documentation justify the higher quantity.
RVU Breakdown, CPT 28292
| Component | Non-Facility | Facility |
|---|---|---|
| Work RVU | 7.25 | 7.25 |
| Practice Expense RVU | 13.02 | 5.74 |
| Malpractice RVU | 0.78 | 0.78 |
| Total RVU | 21.05 | 13.77 |
| Conversion Factor | $33.4009 | |
2026 Medicare Reimbursement by State, CPT 28292
State-level averages across all MAC localities. Non-facility rates typically apply to office-based services; facility rates apply to hospital outpatient / inpatient.
| State | Non-Facility | Facility | Range (Non-Fac) | Localities |
|---|---|---|---|---|
| California | $779.55 | $491.82 | $736.87 - $909.85 | 29 |
| Florida | $729.2 | $485.23 | $697.06 - $760.75 | 3 |
| Georgia | $688.57 | $456.6 | $661.12 - $716.01 | 2 |
| Illinois | $712.99 | $478.04 | $679.92 - $740.7 | 4 |
| Michigan | $687.18 | $458.85 | $668.62 - $705.74 | 2 |
| North Carolina | $664.55 | $437.68 | $664.55 - $664.55 | 1 |
| New York | $774.21 | $502.94 | $673.61 - $823.11 | 5 |
| Ohio | $665.46 | $443.46 | $665.46 - $665.46 | 1 |
| Pennsylvania | $698.16 | $459.98 | $666 - $730.31 | 2 |
| Texas | $695.83 | $456.44 | $662.1 - $725.83 | 8 |
Source: CMS PFSRVU 2026 · Updated 2026-04-01. Full locality-level detail available for all 53 states, contact us for custom reports.
NCCI Bundling Edits, CPT 28292
Procedure-to-procedure (PTP) edits. If you bill any of these codes with 28292 on the same date of service, review the modifier indicator and payer policy before submission.
| Partner Code | Relationship | Modifier Allowed | Rationale |
|---|---|---|---|
| 01470 | Column 1 (primary), can be billed with modifier | No | Anesthesia service included in surgical procedure |
| 01995 | Column 1 (primary), can be billed with modifier | No | Anesthesia service included in surgical procedure |
| 0213T | Column 1 (primary), can be billed with modifier | No | Misuse of Column Two code with Column One code |
| 0216T | Column 1 (primary), can be billed with modifier | No | Misuse of Column Two code with Column One code |
| 0228T | Column 1 (primary), can be billed with modifier | No | Standards of medical/surgical practice |
| 0230T | Column 1 (primary), can be billed with modifier | No | Standards of medical/surgical practice |
| 0490T | Column 1 (primary), can be billed with modifier | Yes | Misuse of Column Two code with Column One code |
| 0566T | Column 1 (primary), can be billed with modifier | Yes | Misuse of Column Two code with Column One code |
| 0594T | Column 1 (primary), can be billed with modifier | Yes | Standards of medical/surgical practice |
| 0596T | Column 1 (primary), can be billed with modifier | Yes | Standards of medical/surgical practice |
Frequently Asked Questions, CPT 28292
What does CPT code 28292 mean? +
CPT code 28292 represents: Cor hlx vlgs rsc prx phlx bs. It's in the Surgery (Musculoskeletal) category with a global period of 090.
What is the Medicare reimbursement for CPT 28292? +
The 2026 Medicare national average non-facility payment for CPT 28292 is $723.26. Rates range from $629.14 to $909.85 across 53 states depending on MAC locality and GPCIs.
What modifiers can I use with CPT 28292? +
Surgery codes commonly use modifier 22 (increased procedural services), 50 (bilateral), 51 (multiple procedures), 52 (reduced services), 58/78/79 (staged, unplanned return, unrelated within global), 62 (co-surgeons), 80/82 (assistant surgeon), and 59 or the X{EPSU} subset for distinct procedural service.
What bundling edits apply to CPT 28292? +
This code has 10 NCCI PTP bundling relationships. See the NCCI Bundling section below for full list.
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Reviewed by the PayerReady Medical Coding Team
Verified against the CMS 2026 code set on July 16, 2026.
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